Female Athlete Triad Symptoms And Injury Surveillance: A Rare Spotlight On Softball

While the Female Athlete Triad and Relative Energy Deficiency in Sport (REDs) are well-documented in endurance and aesthetic sports, team sports, like softball, are rarely considered. PURPOSE: To investigate the prevalence of Triad and REDs symptoms in softball athletes, emphasizing practical monitoring protocols and injury predictors to enhance athlete health. METHODS: Division I softball athletes (n = 35) completed in-house training, injury, and menstrual questionnaires, the Epworth Sleepiness Scale, a dietary recall, and Dual-energy X-ray Absorptiometry scans (DXA). Pearsons and Spearman’s correlations and logistic regressions assessed the relationships between survey responses, reported injuries and DXA variables, and α = 0.05. RESULTS: All DXA scans indicated bone density Z-Scores >0.0. Only three athletes, not using hormonal contraceptives (HC), reported menstrual cycle dysfunction; although, over half of the team reported using HCs. 70% of all athletes were at high risk for low energy availability (LEA: consuming ≤30 kcal/kgLM/day). In addition, LEA was negatively correlated with bone injury incidence (r = -0.418, p = 0.022) and women at high risk for LEA were six times more likely to indicate bone injury (Exp(ß) = 6.271, p = 0.025). Further, musculoskeletal injury (MSKI) was positively correlated with excessive daytime sleepiness (rs = 0.362, p = 0.033) and individuals who scored above the Epworth clinical threshold were three times more likely to suffer a MSKI (Exp(ß) = 3.019, p = 0.026). CONCLUSION: These data showcase a high prevalence of LEA which was also indicative of bone injury; however, most of this team self-reported normal menstrual cycles with and without HC use. Also, sleep quality/quantity may be an underutilized screening tool, as it can inform insufficient recovery and risk of injury. These data partially support studies from female endurance/aesthetic athletes but expose the need for more inclusive research including all sportswomen.